Journal of Musculoskeletal Trauma

Same-site recurrence of an incomplete atypical femoral fracture 8 years after prophylactic intramedullary nailing following bisphosphonate re-exposure in an 81-year-old woman in Korea: a case report: Youngho Cho, Changhun Lim; Received May 31, 2026 Accepted July 1, 2026 Published online September 21, 2026; DOI: https://doi.org/10.12671/jmt.2026.00227 [Epub ahead of print]

Abstract PDF: An 81-year-old woman with osteoporosis presented in April 2024 with recurrent right thigh pain, 8 years after prophylactic intramedullary nailing for an incomplete atypical femoral fracture (AFF) in February 2016. She had a history of bisphosphonate use for approximately 10 years followed by a 5-year drug holiday and three ibandronate infusions before the index fracture in 2016; after a subsequent 4-year antiresorptive-free interval, bisphosphonate therapy was resumed in 2020–2021 following a new vertebral compression fracture. Plain radiographs in 2024 showed recurrent lateral cortical thickening and a transverse radiolucent line at the same site as the previous lesion, with intact hardware. Bone scintigraphy confirmed intense uptake consistent with a recurrent stress reaction. Laboratory testing showed markedly suppressed bone turnover markers, with a serum β-isomerized C-terminal telopeptide of type I collagen (β-CTX) level of 0.048 ng/mL, below the lower limit of the reference range (0.112 ng/mL). The lesion healed during conservative management consisting of bisphosphonate discontinuation, calcium and vitamin D supplementation, retained mechanical stabilization, and a 4-month course of off-label teriparatide. The independent contribution of teriparatide cannot be determined from this single case. This case highlights the rare phenomenon of same-site incomplete AFF recurrence long after prophylactic fixation in association with bisphosphonate resumption and describes successful conservative healing with short-term teriparatide in the presence of preexisting hardware. Level of evidence: V.

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Multiple Stress Fractures Related to Low-dose Adefovir Dipivoxil Treatment in a Patient with Chronic Hepatitis B: A Case Report: Chul Hyun Park, Hyo Sae Ahn, Dong Chul Lee; J Korean Fract Soc 2014;27(4):327-331. Published online October 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.4.327

Abstract PDF: Stress fractures typically result from repeated abnormal mechanical loading to the bones. In particular, multiple stress fractures may occur in patients with systemic disease, such as rheumatoid arthritis, osteoporosis, or osteoarthritis. Adefovir dipivoxil (ADV), a nucleotide analogue of adenosine monophosphate, very rarely causes severe hypophosphatemia when using a low dosage of 10 mg daily for treatment of chronic hepatitis B. To the best of our knowledge, in English literature, this is the first report of multiple stress fractures in a chronic hepatitis B patient who has been treated with a low dosage of ADV. We think it is important to consider that use of ADV in a patient with chronic hepatitis B could be a risk factor for stress fractures.

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Tension Band Plating for a Stress Fracture of the Anterior Tibial Cortex in a Basketball Player: A Case Report: Chul Hyun Park, Woo Chun Lee; J Korean Fract Soc 2012;25(4):323-326. Published online October 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.4.323

Stress fractures of the anterior tibial cortex are prone to complete fracture because these stress fractures occur on the tension side of the bone. Recently, surgical treatments are preferred in high-performance athletes requiring rapid return to sports. We report our experience of a case in which stress fracture of the anterior tibial cortex was treated using anterior tension band plating in a male athlete and successful bony union and rapid return to sports were achieved.

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Stress fractures of the tibia
Jung Min Park, Ki Sun Sung
Arthroscopy and Orthopedic Sports Medicine.2015; 2(2): 95. CrossRef

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Femoral Stress Fractures in Civilians who are not military recruits and athlethes :Two cases report: Myung Ku Kim, Suk Myun Ko, Kyung Ho Mun; J Korean Soc Fract 1998;11(4):784-789. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.784

Abstract PDF: We reports two cases of femoral stress fractures, one at femoral neck, the other at distal femur. Femoral stress fracture is not uncommon in reported literature, but most of reported cases limited in military recruits and athlethes. There are few reports about femoral stress fractures of civilians. Early dignosis is difficult because complaints are vague and poorly localized, so displacement occurs and misdiagnosis is made. The purpose of this report is to call attention to the importance of early diagnosis of stress fracture of the femur so that displacement and misdiagnosis, which may lead to prolonged in capacitation or to the necessity for surgical intervention, may be prevented.

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